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INDONESIA
MEDIA MEDIKA INDONESIANA
Published by Universitas Diponegoro
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Search results for , issue "2012:MMI VOLUME 46 ISSUE 2 YEAR 2012" : 11 Documents clear
Tingkat Ketahanan Hidup Penderita Kanker Nasofaring pada Berbagai Modalitas Terapi Studi Kasus yang Menjalani Terapi Konvensional dan Pengobatan Komplementer Alternatif Jessica Christanti; Awal Prasetyo
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
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Survival rate of patients with nasopharyngeal cancer on various modalitie: Case study of patients on conventional therapy and Indonesian complementary and alternative medicineBackground: There are no data on survival rate of patients with nasopharyngeal cancer (NPC) on complementary alternative medicine in Indonesia. The aim of this study was to analyze the survival rate of patients with nasopharyngeal cancer (NPC) on conventional (modern) and complementary and alternative medicine (CAM) treatments.Methods: A cross-sectional observational study of 33 NPC patients from each conventional (modern) treatment and CAM group was performed. The guided intervews were conducted to describe CAM treatment in NPC patients by using a validated questionnaire based CAM therapies of California Health Interview Survey 2001. Survival analysis was conducted by the Kaplan-Meir method.Results: Most patients (52.3%) used CAM treatments.Multivitamin and herbal medicines were among the commonly used CAM (52.8%). Kaplan-Meier analysis showed no significant results (p=0.444) between groups. The first and second year of survival rate was comparable between groups (66.6% vs. 54.5%; 45.5% vs 33.3%). Furthermore, the median overall survival (OS) was shown (16; 95% CI: 1.58-8.90) in CAM treatment patients and conventional (modern) treatment (12; 95% CI: 8.477-0.00). The prevalenceratio (PR) obtained in this study was 1.2 (95% CI: 0.79-1.69).Conclusion: CAM treatment on NPC patients had no effect on survival rate compared with conventional (modern) treatment.Keywords: NPC, CAM, survival rateABSTRAKLatar belakang: Saat ini, belum ada data tingkat ketahanan hidup penderita kanker nasofaring (KNF) yang menjalani pengobatan komplementer alternatif di Indonesia. Fakta menunjukkan bahwa pengobatan komplementer alternatif di Indonesia merupakan bagian aktivitas sosial budaya. Penelitian ini menganalisis tingkat ketahanan hidup penderita KNF yang memperoleh pengobatan modern konvensional disertai pengobatan komplementer dan alternatif (PKA).Metode: Penelitian cross sectional dilakukan pada 33 penderita KNF di tiap kelompok yang menjalani PKA dan kelompok yang menggunakan pengobatan modern konvensional di wilayah Semarang dan sekitarnya. Wawancara terpimpin untuk terapi PKA dengan menggunakan California Health Interview Survey 2001 yang telah divalidasi. Tingkat ketahanan hidup dianalisis dengan uji Kaplan Meier.Hasil: Sebanyak (52,3%) penderita menjalani PKA, dimana yang tersering adalah dengan multivitamin dan jamu (52,8%). Tingkat ketahanan hidup kelompok PKA di tahun pertama (66,6%) dan tahun ke-2 (45,4%). Tingkat ketahanan hidup tahun pertama dan kedua kelompok obat konvensional 54,5% dan 33,3%. Analisis Kaplan Meier menunjukkan hasil yang tidak bermakna (p=0,444). Analisis median tingkat ketahanan hidup, penderita kelompok PKA didapatkan nilai 16 (CI 95%:1,581-8,900), dan pada kelompok pengobatan modern konvensional didapatkan nilai 12 (CI 95%: 8,477-0,00). Nilai PR didapatkan 1,158 (CI 95%: 0,792-1,692).Simpulan: Penggunaan PKA dan terapi modern konvensional tidak mempengaruhi tingkat ketahanan hidup penderita KNF.
Faktor Risiko Kejang Demam Berulang pada Anak Prastiya Indra Gunawan; Darto Saharso
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
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Risk factors of recurrent febrile seizures in childrenBackground: Febrile seizures (FS) are the most common seizure disorder in childhood. Recurrent febrile seizures (RFS) occur in one third of children who experience a first FS. About nine percent had three or more recurrence. Little is known about predictors of recurrence. The aim of this study is to determine the incidence and the risk factors of RFS in children with FS at Dr. Soetomo Hospital Surabaya.Method: This is a cohort prospective study. Data was taken from all children with first FS aged 6 month-old to 5 year-old who were admitted at pediatric ward Dr. Soetomo Hospital from August 2009 to November 2010. They were observed for one year period to ascertain wether FS recurred. Logistic regression statistic was used to analyze those variables including sex, age, body temperature during the fever episode, family history of seizures, diagnosis at the first onset, maternal illness, abnormal delivery and recurrence ofFS.Results: Recurrent FS occured in 65% of the 100 children at one year observation, and 26% of them had further attack. Male to female ratio was 2:1. Thirty-one (77.5%) of subjects were less than 12 months-old. Body temperature ≤38.5OC (OR=5.50, 95%CI, p=0.019) and complex FS (OR 5.03, 95%CI, p=0.025) were related to increase risk of reccurence.Conclusions: The risk of RFS increased with body temperature ≤38.5OC and diagnosed as complex FS at the first FS.Keywords: Children, risk factors, recurrent febrile seizures ABSTRAKLatar belakang: Kejang demam (KD) adalah kasus kejang yang sering dialami anak-anak. KD berulang terjadi pada sepertiga anak yang mengalami KD pertama. Sekitar 9% dari penderita KD mengalami tiga atau lebih kejadian berulang. Hanya sedikit yang diketahui tentang prediktor berulangnya KD. Tujuan penelitian untuk mengetahui angka kejadian KD berulang dan menentukan faktor risiko terjadinya KD berulang pada anak yang mengalami KD di RSUD Dr. Soetomo Surabaya.Metode: Studi kohort prospektif dilakukan pada bulan Agustus 2009 sampai November 2010. Subyek diambil dari anak usia 6 bulan sampai 5 tahun yang menderita KD pertama yang MRS di RSUD Dr. Soetomo. Subyek diamati selama 1 tahun untuk menentukan apakah KD terjadi berulang. Analisis antar variabel jenis kelamin, usia, suhu badan saat terjadi demam, riwayat kejang pada keluarga, diagnosis awal, penyakit ibu, kelahiran yang tidak normal dan kejadian KD berulang, dilakukan dengan regresi logistik.Hasil: KD berulang terjadi 65% pada 100 anak yang diobservasi selama 1 tahun pertama dan 26% mengalami KD lebih dari 2 kali. Rasio laki-laki dibanding perempuan adalah 2:1. Tiga puluh satu (77,5%) anak berusia kurang dari 12 bulan. Faktor risiko suhu badan ≤38,5OC (OR=5,50, 95%CI, p=0,019) dan KD komplikata (OR 5,03, 95%CI, p=0,025) bermakna secara signifikan untuk kejadian berulangnya KD.Simpulan: Risiko KD berulang pada anak meningkat pada suhu badan ≤38,5OC dan diagnosis KD komplikata pada saat KD pertama.
Karakteristik Klinik dan Laboratorik Kolestasis Intrahepatal dan Ekstrahepatal di Bangsal Perawatan Anak RSU Dr. Saiful Anwar Malang Satrio Wibowo; Nurtjahjo Budi Santoso
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Clinical and laboratory characteristics of intrahepatic and extrahepatic cholestasis in pediatric ward of Dr. Saiful Anwar General Hospital MalangIntroduction: Clinical examination in determining intrahepatic and extrahepatic cholestasis in children and infant remains invasive and difficult. There is a need of simple and aplicative method on clinical practice. The objective of this review is to find the cause of cholestasis based on clinical and laboratory examination. Subject and Methode: Sixty nine medical records from pediatric patients who suffered from prolonged conjugated jaundice between January 2008 and March 2011 in the Department of Pediatrics of Dr. Saiful Anwar General Hospital, Malang, Indonesia were reviewed with regard to the clinical examinations, laboratory parameters and ultrasound. Liver ultrasound was used to classify patients into two groups: intra or extrahepatic cholestasis. Unpaired t-test was performed to compare numerical data. P value less than 0.05 were considered as to indicate statistical significant.Results: Leucocytes count (mean 2.649/mm3, 95%CI 1.556 to 12.141/mm3, p=0.012), ALT (mean 155 IU/L, 95%CI 66.9 to 245 IU/L, p=0.043), cholesterol (mean 243 mg/dl, 95%CI 31 to 455 mg/dl, p=0.026) and triglyseride (mean 219 mg/dl, 95%CI 40 to 398 mg/dl, p=0.018) were significantly higher in patients with extrahepatic cholestasis than intrahepatic group, but potassium level (mean 1.18 mEq/L, 95%CI 0.22 to 2.14 mEq/L, p=0.017) were significantly lower in intrahepatic group. Pale stool color had 75%sensitivity and 80% spesificity in determining extrahepatic cholestasis.Conclusion: Elevated leucocyte count, increased ALT serum level, cholesterol, triglyseride and decreased of potassium and acholic stool can be used as determinant factors in classifying intra or extrahepatic cholestasis in children.Keywords: Acholic stool, leucocyte, ALT, cholesterol, triglyseride, potassium, cholestasisABSTRAKLatar belakang: Diagnosis pasti kolestasis intrahepatal dan ekstrahepatal pada bayi dan anak membutuhkan pemeriksaan yang invasif dan sulit. Dibutuhkan metode yang sederhana dan aplikatif untuk praktek klinis. Penelitian ini bertujuan untuk menentukan jenis kolestasis intrahepatal berdasarkan pemeriksaan klinis dan laboratoris.Metode: Enam puluh sembilan rekam medis pasien yang pernah dirawat di bangsal anak RSU Dr. Saiful Anwar Malang dengan kolestasis selama periode Januari 2008 sampai Maret 2011 dianalisis. USG digunakan untuk menentukan ada tidaknya sumbatan ekstrahepatal dan menentukan kelompok kolestasis intrahepatal atau ekstrahepatal. Identitas, keluhan, riwayat penyakit dan hasilhasil pemeriksaan laboratorium dibandingkan antara dua kelompok penelitian. Unpaired t-test digunakan untuk membandingkandata numerik dari dua kelompok yang diteliti.Hasil: Leukosit (rerata 2,649/mm3, 95%CI 1.556-12,141/mm3, p=0,012), ALT (rerata 155 IU/L, 95%CI 66,9-245 IU/L, p=0,043), kolesterol (rerata 243 mg/dl, 95%CI 31-455 mg/dl, p=0,026) dan trigliserida (rerata 219 mg/dl, 95%CI 40-398 mg/dl, p=0,018) lebih tinggi pada pasien dengan kolestasis ekstrahepatal dibandingkan dengan intrahepatal, namun kadar kalium (rerata 1,18 mEq/L, 95% CI 0,22-2,14 mEq/L, p=0,017) lebih rendah. Warna tinja pada kedua jenis kolestasis juga berbeda. Warna tinja yang pucat memiliki sensitivitas 75% and spesifisitas 80% dalam menentukan kolestasis ekstrahepatal.Simpulan: Peningkatan jumlah leukosit, ALT, kolesterol, trigliserida dan penurunan kadar kalium darah serta warna
Proteksi Probiotik pada Mukosa Ileum Mencit yang Terpajan Lipopolisakarida Escherichia Coli Alpha Fardah Athiyyah; Ariani Setiawati; Andy Darma; Anang Endaryanto; I Ketut Sudiana; Reza Ranuh; Subijanto MS
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Probiotic’s protection in ileal mucosa of mice after lipopolysaccaride Escherichia coliBackground: Gastrointestinal infection is one of the major causes of morbidity in children. Diarrhea is the common manifestation. Diarrheal prevention needs a balance mucosal immune system. Probiotic used in prevention of gastrointestinal infection needs to be considered. The aim of the study is to prove probiotic protection in ileal mucosa after lipopolysaccaride (LPS) Escherichia coli O55:B5 inoculation anatomically and immunologically.Method: Experimental study with male Balb/c, age 10-12 weeks, body weight 30-40g and randomized into treatment group and placebo group. Treatment group received mix probiotic for 14 days and on day 15 were inoculated by LPS Escherichia coli O55:B5, and day 16-21 were given mix probiotic again. Placebo group received LPS Escherichia coli O55:B5 on day 15. Mice necropsy were conducted at day 22. Immunohistochemistry examination used to look for amount expression cell for IL-2, IFN-γ, TNF-α, IL-4, IL-5,IL-6, IL-10 dan TGF-β in ileal mucosa. Scanning electron microscope was used to see ileal mucosal structure. Statistic analysis used in this study was multivariate analysis.Results: Sixteen Balb/c mices were randomized into 2 groups, each group consist 8 mices. There was significant difference on amount of cells expression IL-5 (p=0.022), IL-6 (p=0.05), and also on amount of cells expression TGF-β (p=0.036). On probiotic- LPS group, there was no Th1 domination but on the other hand, Treg became dominant. Th1 and Th2 response were still balance. Structural damages occurred in LPS group and did not occur in probiotic-LPS group.Conclusion: Probiotic protection in ileal Balb/c mice mucosa after LPS Escherichia coli O55:B5 inoculation is through anatomy and immunology changes.Keywords: Probiotic, LPS, Escherichia coli, protection, immunologyABSTRAKLatar belakang: Infeksi gastrointestinal dengan manifestasi tersering diare merupakan salah satu infeksi yang sering terjadi pada anak. Pencegahan diare memerlukan keseimbangan sistem imun mukosa yang baik. Penggunaan probiotik untuk pencegahan terhadap infeksi gastrointestinal perlu dipikirkan. Penelitian ini bertujuan untuk membuktikan proteksi probiotik pada ileum mencit yang terpajan lipopolisakarida (LPS) Escherichia coli O55:B5 secara anatomis dan imunologis.Metode: Uji eksperimental dengan menggunakan mencit Balb/c jantan berusia 10-12 minggu, berat badan 30-40g dan dirandomisasi menjadi kelompok perlakuan dan kelompok kontrol. Kelompok perlakuan mendapatkan mix probiotik selama 14 hari, hari ke-15 mendapatkan LPS Escherichia coli O55:B5 dan hari ke-16-21 kembali mendapatkan mix probiotik. Kelompok kontrol mendapatkan LPS Escherichia coli O55:B5 saja pada hari ke-15. Seluruh mencit dinekropsi pada hari ke-22. Pemeriksaan imunohistokimia untuk melihat ekspresi sel penghasil sitokin IL-2, IFN-, TNF-α, IL-4, IL-5, IL-6, IL-10 dan TGF-ß di jaringan ileum. Scanning microscope electron (SEM) untuk melihat struktur mukosa ileum. Analisis statistik yang digunakan adalah analisis multivariat.Hasil: Enam belas ekor mencit Balb/c terbagi menjadi dua kelompok, masing-masing 8 mencit. Pada kelompok probiotik-LPS didapatkan perbedaan bermakna dibandingkan dengan kelompok LPS pada jumlah penghasil sitokin IL-5 (p=0,022), IL-6 (p=0,050) dan jumlah sel penghasil sitokin TGF-β (p=0,036). Pada kelompok probiotik-LPS, dominasi respon Th1 tidak terlihat lagi dan menimbulkan dominasi Treg pada kelompok ini. Posisi Th1 dan Th2 masih dapat dipertahankan secara seimbang. Kerusakan struktur yang terjadi pada kelompok LPS tidak didapatkan pada kelompok Probiotik-LPS.Simpulan: Proteksi probiotik pada mukosa ileum yang terpajan LPS Escherichia coli terjadi secara anatomi dan imunologi.
Uji Banding Efektivitas Kalsipotriol Topikal, Suction Blister Grafting dan Kombinasi Keduanya pada Terapi Repigmentasi Lesi Vitiligo Stabil Diana Nurhayati
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
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Comparison study the efficacy of topical calcipotriol, suction blister grafting and combination of both therapies for repigmentationc of stable vitiligoBackground: Stable vitiligo is defined as non-progressive vitiligo for more than 6-month. A large variety of therapeutic agents are being tried, but an optimal treatment is not yet available. Topical calcipotriol is one of those agent that hypothetically can stimulate repigmentation of vitiliginous lesions. Suction-blister-grafting (SBG), is one of the surgical therapies for replenishment of melanocytes in stable vitiligo. The aim of this study was to compare the efficacy of topical calcipotriol, SBG and the combination of both therapies in the treatment of stable vitiligo.Methods: Twenty-one stable vitiligo (focal, segmental, and generalized) patients were selected for study. Patients were divided into three groups. First-groups were advised to apply topical calcipotriol (50ug/mg) twice-daily over the vitiliginous patches. Secondgroups were given with SBG, and third-groups were given with combination of both treatments. The main outcome measurement was the evaluation of the percentage of repigmentation in treated target lesions in 12-weeks.Results: After12-weeks periods, the combination therapies were found more effective than single therapy. The combination therapies-treated areas showed marked intense repigmentation improvement 19.1% compared to 15.1% on the SBG-only side (p<0.05). Calcipotriol was found to induce initiating repigmentation, but was not statistically significant.Conclusion: Combination therapy of SBG and topical calcipotriol is more effective than single therapy for stable vitiligo.Keywords: Stable vitiligo, suction-blister-grafting, calcipotriol, repigmentation.ABSTRAK Pendahuluan: Vitiligo stabil merupakan vitiligo yang tidak berkembang dalam jangka waktu minimal 6 bulan. Berbagai jenis terapi telah banyak dicoba, akan tetapi terapi yang optimal belum tersedia sampai saat ini. Kalsipotriol topikal merupakan salah satu bahan yang diduga mampu menstimulasi repigmentasi pada lesi vitiligo. Suction blister grafting (SBG) merupakan salah satu tindakan bedah yang dapat dipakai untuk mengganti melanosit pada vitiligo stabil. Tujuan penelitian adalah untuk membandingkan efektivitas kalsipotriol topikal, SBG dan kombinasi keduanya untuk terapi vitiligo stabil.Metode: Penelitian ini dilakukan pada dua puluh satu pasien vitiligo stabil (fokal, segmental dan generalisata). Pasien dibagi menjadi tiga kelompok. Kelompok pertama diberi kalsipotriol topikal (50ug/mg) dioleskan dua kali/hari, kelompok kedua dilakukan tindakan suction blister grafting, dan kelompok ketiga diberi keduanya. Hasil dinilai berdasarkan persentase repigmentasi pada area yang di terapi pada akhir minggu ke-12.Hasil: Pada akhir minggu ke-12, terapi kombinasi terbukti lebih efektif daripada terapi tunggal. Pada lesi yang diterapi kombinasi tampak adanya perbaikan repigmentasi 19,1% dibandingkan terapi SBG tunggal yang 15,1% (p<0,05). Kalsipotriol juga terbukti dapat memicu terjadinya repigmentasi awal, meskipun repigmentasinya secara statistik tidak signifikan.Simpulan: Kombinasi terapi SBG dan kalsipotriol topikal merupakan terapi yang lebih efektif dibandingkan dengan terapi tunggal pada terapi vitiligo stabil
Photodynamic Therapy As an Adjuvant Therapy for Local-Partial Remission of Nasopharyngeal Carcinoma After Standard Therapy in Sardjito Hospital Yogyakarta A Five-Year-Overall Survival Rate Analysis Study Bambang Hariwiyanto; Sagung Rai Indrasari; Camelia Herdini; Tan IB
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
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Background: The foremost problems of nasopharyngeal carcinoma (NPC) management are high loco-regional remission, local recurrence and spreading rate post therapy. Photodynamic therapy (PDT) has been done for treatment of tumors less than 1 cm in size and depth in a very difficult location, where radical excision by surgery was not possible. The aim of this study is determining 5-year-overall survival rate of local-partial remission of NPC after standard therapy followed by additional PDT.Method: The survival study is subjected to the 5 years-overall survival rate of local-partial remission. Photosensitizer (FoscanR) 0,15mg/kgBW was injected to NPC patients and followed by 20 joule/cm2, 642 wave length and 100 watts/cm2 irradiants non thermal laser illumination 96 hours after injection. The PDT result was confirmed with biopsy, CT scan, upper abdominal USG, thoracic radiograph and bone survey for 12 weeks after treatment. Follow up was done every 3 months in first year, continued every 6 months in the second year, and followed once a year. The sample collected from January 2005 to December 2010, and 33 cases met the inclusion and exclusion criterias, but only 20 cases were eligible inclusion criteria. The 5 years-overall survival was defined as the time from diagnosis to death from any cause or last follow up, calculated by Kaplan Meier survival analysis.Results: The 5-year-overall survival rate was 50%.Conclusion: PDT as an additional treatment for small local-partial remission in NPC post treatment is an alternative therapy to improve the treatment outcome and survival rate.Keywords: NPC, PDT, 5-year-survival rate ABSTRAK Photodynamic therapy sebagai terapi ajuvan karsinoma nasofaring remisi lokal-parsial setelah terapi standar di RSUP Dr. Sardjito Yogyakarta: Studi analisis angka kehidupan lima tahunLatar belakang: Problem utama terapi standar karsinoma nasofaring (KNF) adalah rendahnya angka keberhasilan terapi, terutama adanya remisi parsial, baik pada tumor primer maupun metastasis. Photodynamic therapy (PDT) telah digunakan untuk pengobatan tumor di superfisial, dengan diameter kurang dari 1 cm, terutama pada tumor yang letaknya tersembunyi dan sulit dioperasi secara radikal. Penelitian ini bertujuan menentukan angka kehidupan 5 tahun pada penderita KNF dengan remisi parsial pada tumorprimernya, setelah diterapi secara standar dan dilakukan PDT sebagai terapi tambahan.Metode: Studi analisis kesintasan terhadap kehidupan 5 tahun penderita KNF yang mengalami remisi lokal-parsial setelah terapi standar dan PDT. Photosensitizer (FoscanR) 0,15mg/kgBW diinjeksikan pada penderita KNF, dan setelah 96 jam, dilanjutkan dengan irradiants non thermal laser illumination sebesar 20 joule/cm2, panjang gelombang 642 dan 100 watts/cm2. Hasil PDT dikonfirmasi dengan biopsi, CT scan, USG abdomen, rontgen thoraks dan bone survey pada 12 minggu setelah terapi. Tahun pertama, dilakukan follow up setiap 3 bulan, di tahun kedua setiap 6 bulan, dan selanjutnya setiap setahun sekali. Sampel didapat dari Januari 2005 sampai Desember 2010, dimana 33 pasien KNF post PDT memenuhi kriteria inklusi dan eksklusi, namun hanya 20 pasien yang memenuhi kriteria inklusi 5-tahun-follow up. Angka kehidupan 5 tahun ditentukan berdasarkan saat diagnosis sampai kematian penderita, atau sampai folllow up terakhir, dihitung dengan analisis kesintasan Kaplan Meier.Hasil: Angka kehidupan keseluruhan selama 5 tahun adalah 50%.Simpulan: PDT sebagai tambahan terapi terhadap KNF yang
Asupan Energi, Karbohidrat, Serat, Beban Glikemik, Latihan Jasmani dan Kadar Gula Darah pada Pasien Diabetes Mellitus Tipe 2 Fitri RI; Yekti Wirawanni
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Energy intake, carbohydrate intake, fiber intake, glycemic load, exercise and blood glucose levels in patients with type 2 diabetes mellitusBackgrounds: The worldwide prevalence of type 2 diabetes mellitus (DM) is increasing at epidemic proportion. Dietary patterns and sedentary lifestyle are risk factors of type 2 DM.Objective: The study aimed to examine the association between carbohydrate intake, total energy intake, fiber intake, glycemic load, frequency of exercise and duration of exercise with fasting blood glucose levels and with 2h postprandial blood glucose levels. Method: In this observational study with crossectional approach, 46 adults with type 2 DM. The subjects consisted of 17 male and 29 female. This study was performed at Dr. Kariadi Hospital during February-March 2008. Data on food consumption was obtained using semi quantitative food frequency questionnaire (FFQ) and recall. Data on exercise was obtained using questionnaire. Data on blood glucose level was obtained from medical records. Data analysis used Pearson Product Moment and multiple regression to test this associations.Results: Most (76.1% and 78.3%) subjects had high fasting blood glucose and 2h pp. In bivariate analysis, significant associations with fasting blood glucose level were observed for carbohydrate intake (r=0.638, p=0.000), total energy intake (r=0.539, p=0.000), fiber intake (r=-0.670, p=0.000), glycemic load (r=0.345, p=0.019), frequency of exercise (r=-0.561, p=0.000), and duration of exercise (r=-0.393, p=0.007). Significant associations with 2h postprandial blood glucose level were also observed for total energy intake (r=0.673, p=0.000), fiber intake (r=-0.638, p=0.000), glycemic load (r=0.775, p=0.000), frequency of exercise (r=-0.482, p=0.001), and duration of exercise (r=-0.393, p=0.007). Fiber intake, frequency of exercise and duration of exercise were negatively associated with fasting blood glucose levels and with 2h postprandial blood glucose levels. Carbohydrate intake, total energy intake, fiber intake, glycemic load, frequency of exercise and duration of exercise influenced 69.7% fasting blood glucose levels and 71.3%2h blood glucose levels.Conclusion: The unsuccessful blood glucose level central are associated with food intake glycemic index of the food and physical activity.Keywords: Carbohydrate intake, total energy, fiber, glycemic load, exercise, blood glucose levels, type 2 diabetes mellitus ABSTRAKLatar belakang: Prevalensi diabetes mellitus (DM) tipe 2 meningkat secara epidemologis di seluruh dunia. Pola makan dan pola hidup santai merupakan faktor risiko DM tipe 2.Tujuan: Menjelaskan hubungan asupan energi, asupan karbohidrat, asupan serat, beban glikemik, frekuensi latihan jasmani dan durasi latihan jasmani dengan kadar gula darah puasa dan kadar gula darah 2 jam postprandial (2 jam pp).Metode: Penelitian ini bersifat observasional dengan pendekatan belah lintang dilaksanakan di Rumah Sakit Dr. Kariadi Semarang selama bulan Febuari-Maret 2008 dengan 46 pasien DM sebagai subyek penelitian, yang terdiri atas 17 orang laki-laki dan 29 orang perempuan. Data asupan makanan diperoleh dengan formulir frekuensi makan semi kuantitatif dan recall. Data latihan jasmani diperoleh dengan kuesioner. Data kadar gula darah diperoleh dari buku rekam medik. Analisis data menggunakan korelasiPearson Product Moment dan regresi linear ganda.Hasil: Sebagian besar (76,1%) dan (78,3%) subyek mempunyai kadar gula darah puasa dan 2 jam pp dengan kategori tinggi. Terdapat hubungan bermakna untuk kadargula darah puasa dengan asupan energi (r=0,539, p=0,000), karbohidrat (r=0,638, p=0,000), serat (r=-0,670, p=0,000), beban glikemik (r=0,345, p=0,019), frekuensi latihan jasmani (r=-0,561, p=0,000) dan durasi latihan jasmani (r=-0,393, p=0,007). Terdapat hubungan bermakna antara kadar gula darah 2 jam pp dengan asupan energi (r=0,673, p=0,000), asupan serat (r=-0,638, p=0,000), beban glikemik (r=0,775, p=0,000), frekuensi latihan jasmani (r=-0,482, p=0,001) dan durasi latihan jasmani (r=-0,393, p=0,007). Asupan energi, karbohidrat, serat, beban glikemik, frekuensi latihan jasmani dan durasi latihan jasmani secara bersama-sama mempengaruhi 69,7% kadar gula darah puasa, dan 71,3% kadar  gula darah 2 jam pp.Simpulan: Ketidakberhasilan pengendalian kadar gula darah berhubungan dengan asupan dan beban glikemik makanan serta aktivitas fisik yang rendah.
Pajanan Pestisida Sebagai Faktor Risiko Hipotiroidisme pada Wanita Usia Subur di Daerah Pertanian Suhartono Suhartono; RRJ. Sri Djokomoeljanto; Suharyo Hadisaputro; Hertanto Wahyu Subagio; Apoina Kartini; Suratman Suratman
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Pesticide exposure as a risk factor for hypothyroidism in women at childbearing age in agricultural areasBackground: Hypothyroidism in women at childbearing age (WCA) will cause reproduction disorder, i.e. infertility, spontaneous abortion, impaired growth and development of foetus, placental abruption, and preterm delivery. Pesticide exposure is suspected to cause hypothyroidism. The research objective is to prove that pesticide exposure is a risk factor for hypothyroidism among WCA in agricultural areas.Methods: Case-control studies were used as study designs. Study subjects were 44 WCA as cases and 45 WCA as controls. Pesticide exposure was measured by asking WCA’s involvement in agricultural activities using structured questionnaire and by checking their levels of cholinesterase. Hypothyroidism was determined based on the results of TSH, FT4, and T3 level. Confounding variables were also measured. These variables were age, body mass index (BMI), participation in hormonal contraception, liver function, urinaryiodine excretion, urinary thiocyanate level and blood lead level. Chi-square test, OR (95% CI), and multivariate logistic regression were implemented to test the hypothesis.Results: Pesticides exposure is a risk factor for hypothyroidism (crude-OR=3.04; 95% CI=1.20-7.81; nilai p=0.033 and adjusted OR=3.31, 95% CI=1.25 to 8.78, p=0.016). The higher the degree of exposure, the greater the risk of having hypothyroidism.Conclusion: Pesticides exposure is a risk factor for hypothyroidism among WCA in agricultural areas.Keywords: Pesticide exposure, risk factor, hypothyroidism, women at childbearing age, agricultural areaABSTRAKLatar belakang: Hipotiroidisme pada kelompok wanita usia subur (WUS) dapat menyebabkan gangguan reproduksi, seperti infertilitas, abortus spontan, gangguan tumbuh-kembang janin, dan kelahiran prematur. Pajanan pestisida dapat mengganggu fungsi tiroid. Tujuan penelitian adalah membuktikan bahwa pajanan pestisida merupakan faktor risiko hipotiroidisme pada WUS di daerah pertanian.Metode: Desain penelitian yang digunakan adalah kasus-kontrol. Subyek penelitian adalah 44 WUS sebagai kasus dan 45 sebagai kontrol. Pajanan pestisida diukur menggunakan kuesioner dan pemeriksaan kadar kolinesterase. Kejadian hipotiroidisme diukur menggunakan parameter kadar TSH, FT4 dan T3. Variabel perancu yang diukur meliputi umur, indeks massa tubuh (IMT), penggunaan KB hormonal, fungsi hati, ekskresi yodium urin, kadar tiosianat urin, dan kadar Pb darah. Uji hipotesis yang digunakanadalah uji Chi-square, uji OR (95%CI), dan regresi logistik multivariat.Hasil: Pajanan pestisida merupakan faktor risiko hipotiroidisme pada WUS di daerah pertanian (crude-OR=3,04; 95%CI=1,20- 7,81; nilai p=0,033 dan adjusted OR=3,31; 95%CI=1,25-8,78; p=0,016). Semakin tinggi derajat pajanan pestisida, semakin besar risiko terjadinya hipotiroidisme.Simpulan: Pajanan pestisida merupakan faktor risiko kejadian hipotiroidisme pada WUS di daerah pertanian.
Phytoestrogen Genistein and Black Cohosh and Marker of BMD in Menopausal Women Rizani Amran; Adenan Abadi; Theodorus Theodorus; Elvi Widiastuti
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Background: In Indonesia, phytoestrogens can be found in the market as supplement to resolve climacteric complaint and osteoporosis. This phytoestrogens has not been proven scientifically to have benefit in overcoming the climacteric complaints and osteoporosis in menopausal women. Therefore, it is important to have clinical test searching data for knowing the increase of bone mineral density (BMD).Methods: The design was comparison clinical test in the form of “add on” with double blind in Hospital of Mohammad Hoesin Palembang started in August 2010 until February 2011 putting subjects into fitoestrogen and placebo groups randomly. T-score of spine and femur were measured using done densitometry before and after 6 months supplementation.Results: In the beginning of study, it was found that the average of spine T-score in the group of phytoestrogens was -1.455±0.264 after 6 months it increased to -1.295±0.223 with change 0.160±0.153 (p=0.001).Whereas in placebo group the average of spine T-score at the beginning of the study was -1.295±0.223 becoming -1.560±0.414 with decrease of -0.100±0.273 (p=0.118). Femur T-score level, of phytoestrogens group at the beginning of the study was -1.415±0.215, after 6 months it became -1.270±0.141 with change of 0.145±0.170 (p=0.001). In placebo group, the average of femur T-score was -1.475±0.202 becoming -1.595±0.421 with of decrease -0.120±0.33 (p=0.124). The status of spine and femur T-score BMD both in, phytoestrogens and placebo group was osteopenia at the beginning of the study. After 6 months, spine T-score in phytoestrogens group did not change, and in placebo group, 2 subject showed osteoporosis with spine T-score and femur T-score -2.7 and -2.75(±0.212).Conclusions: The administration of phytoestrogens is able to maintain bone mineral density and prevent the occurrence of osteoporosis.Keywords: Phytoestrogens, BMD, T-score, menopauseABSTRAK Fitoestrogen genistein dan black cohosh dan penanda BMD pada perempuan menopauseLatar belakang: Di Indonesia, fitoestrogen beredar di pasaran sebagai suplemen untuk mengatasi keluhan klimakterik dan osteoporosis. Fitoestrogen ini belum terbukti secara ilmiah bermanfaat untuk mengatasi keluhan klimakterik maupun osteoporosis pada perempuan menopause. Oleh karena itu uji klinik ini dilakukan untuk mencari data guna mengetahui meningkatnya gambaran BMD.Metode: Desain adalah uji klinik berpembanding dalam bentuk add on, secara tersamar ganda di RS Dr. Mohammad Hoesin Palembang bulan Agustus 2010 sampai dengan Februari 2011 pada subyek yang dibagi dalam kelompok fitoestrogen dan placebo secara acak. Variabel yang diukur adalah skor T tulang vertebra dan femur menggunakan bone densitometer sebelum dan setelah 6 bulan mendapat suplemen.Hasil: Pada awal penelitian rerata T-skor tulang belakang kelompok fitoestrogen -1,455±0,264 setelah 6 bulan menjadi -1,295±0,223 dengan perubahan 0,160 ± 0,153 (p=0,001). Sedangkan kelompok plasebo rerata T-skor tulang belakang pada awal penelitian -1,295±0,223 menjadi -1,560±0,414 dengan penurunan -0,100±0,273 (p=0,118). Pada kadar T-skor femur, di awal penelitian kelompok fitoestrogen -1,415±0,215 setelah 6 bulan menjadi -1,270±0,141 dengan besaran perubahan 0,145±0,170 (p=0,001). Pada kelompok plasebo rerata T-skor femur pada awal penelitian -1,475±0,202 menjadi -1,595±0,421 dengan perubahan -0,120±0,33 (p=0,124). Status BMD T-skor tulang belakang dan femur di awal penelitian, kelompok fitoestrogen dan kelompok plasebo adalah osteopeni. Setelah 6 bulan kemudian, pada kelompok fitoestrogen tidak terdapat perubahan status BMD sedangkan pada kelompok plasebo terdapat 2 orang yang densitas mineral tulangnya mengalami perubahan menjadi osteoporosis dengan rerata T-skor tulang belakang -2,70 dan T-skor femur -2,750 ± 0,212.Simpulan: Pemberian fitoestrogen dapat mempertahankan densitas mineral tulang dan mencegah terjadinya osteoporosis.
Are GSTM1 Null and GSTT1 Null Risk Factor of Autism Spectrum Disorder? A Preliminary Study Donna Hermawati; Sue-Mian Then; Tri Indah Winarni; Rahman Jamal; Sultana MH Faradz
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Background: Low plasma total glutathione (tGSH) levels, elevated levels of oxidized glutathione (GSSG) and low ratios of tGSH to GSSG in autism were reported. Glutathione S-transferases (GST) are antioxidant enzymes that play important role in cellular detoxification and the excretion of environmental pollutants including heavy metals. Glutathione S-transferase mu (GSTM1) and Glutathione S-transferase theta (GSTT1) are known to be highly polymorphic. Homozygous deletions of these genes result in lack ofenzyme activity and impaired the ability to excrete metals including mercury. Combined effects of mercury (Hg) accumulation coupled with decreased levels of antioxidants (low glutathione and antioxidant enzymes) contribute to the phenotypic presentation of autism spectrum disorder (ASD). Association of GSTM1 null genotype with autism has been reported. Therefore the preliminary study was performed to investigate the role of GSTM1 null and GSTT1 null as risk factor of ASD associated with phenotype expression.Method: Fifty one ASD patients were recruited from special need & autism school and 45 controls from Semarang & Solo. Blood veins samples were collected and genomic DNA was extracted by salting-out method in CEBIOR Semarang. Genotyping for GSTM1 and GSTT1 gene was done in UMBI Malaysia. Multiplex PCR was performed and PCR products were separated on 1.2 % agarose gel, stained with ethidium bromide and visualized on UV transiluminator. GSTM1 & GSTT1 gene product is about 625 bp and 459 bp. Absence of GSTM1 and GSTT1 gene band was interpreted as GSTM1 null & GSTT1 null.Results: The frequency of GSTM1 null and GSTT1 null in ASD higher compared with control group but the difference is not statistically significant (p=0.357, OR=0.504; 95% CI 0.117-2.168 and p=0.364, OR=0.674; 95% CI 0.287-1.580). There is also no statistically different in the distribution of GSTM1 null and GSTT1 null between mild to moderately autistic and severely autistic (p=0.983, OR=0.980; 95% CI 0.158-6.095 and p=0.439, OR=1.633; 95% CI 0.471-5.656).Conclusion: GSTM1 null and GSTT1 null are not risk factor of ASD. Further investigations are needed with a bigger sample size, analyzing multiple GST genes and GST activity determination to find out the gene susceptibility of ASD and factors that contribute to the phenotype expression of ASD.Keywords: GSTM1 null, GSTT1 null, risk factor, autism spectrum disorder ABSTRAKApakah GSTM1 Null dan GSTT1 Null merupakan faktor risiko autism spectrum disorder? Studi pendahuluanLatar belakang: Pada autism ditemukan bahwa glutathion total plasma (tGSH) rendah, oxidized glutathione (GSSG) meningkat dan rasio tGSH terhadap GSSG rendah. Glutathione s-transferase (GST) merupakan enzim antioksidan yang berperan penting dalam proses detoksifikasi seluler dan ekskresi polutan lingkungan termasuk diantaranya logam berat. Polimorfisme gen GST mu (GSTM1) dan GST theta (GSTT1) cukup tinggi. Delesi homozigot gen GSTM1 dan GSTT1 yang menyebabkan berkurang sampai tidak adanya aktivitas enzim GST serta menurunnya level antioksidan berkontribusi terhadap risiko ASD. Oleh karena itu dilakukan penelitian pendahuluan untuk mengetahui hubungan antara gen GSTM1 null dan GSTT1 null sebagai faktor risiko ASD dengan ekspresi fenotip.Metode: Lima puluh satu pasien ASD dari SLB dan sekolah autis serta 45 kontrol dari Semarang dan Solo diambil darah vena, kemudian diekstraksi dengan metode salting-out diCEBIOR Semarang. Pemeriksaan genotip gen GSTM1 & GSTT1 dilakukan di UMBI Malaysia. Metode yang digunakan adalah PCR multipleks, setelah itu produk PCR dipisahkanpada 1,2% gel agarosa kemudian dicat dengan ethidium bromida dan hasilnya dilihat menggunakan transiluminator UV. Besar produk untuk GSTM1 & GSTT1 adalah 625 bp &459 bp. Tidak adanya band untuk gen GSTM1 & GSTT1 diinterpretasikan sebagai GSTM1 null & GSTT1 null.Hasil: Frekuensi gen GSTM1 null dan GSTT1 null pada ASD lebih tinggi dibandingkan kontrol tetapi tidak ditemukan perbedaan yang signifikan (p=0,357, OR=0,504; 95% CI0,117-2,168 and p=0,364, OR=0,674; 95% CI 0,287-1,580). Distribusi gen GSTM1 null dan GSTT1 null pada autis ringan sedang dan autis berat juga tidak ditemukan perbedaan yang signifikan secara statistik (p=0,983, OR=0,980; 95% CI 0,158-6,095 and p=0,439, OR=1,633; 95% CI 0,471-5,656).Simpulan: GSTM1 null dan GSTT1 null bukan merupakan faktor risiko ASD. Penelitian lebih lanjut sangat diperlukan dengan jumlah sampel yang lebih besar, analisis gen GSTmultipel dan pemeriksaan aktivitas GST untuk mendapatkan gen faktor risiko ASD dan faktor-faktor yang mempengaruhi ekspresi fenotip ASD.

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